Complementary and Alternative Medicine for children with ADHD

Complementary and alternative medicine (CAM) is increasingly being used for children with ADHD.

CAM therapies focus on treating the patient holistically and individually, and aim to treat underlying etiologies.

Various commonly used CAM modalities will be discussed in the following section

Diet

Parents who are troubled with medicating their children are often more comfortable with the initiative of dietary interventions.

Proper nutrition is essential for growing children, and children who eat a diet high in “junk food” in early childhood are more likely to exhibit hyperactivity by age seven; this may reflect a long-term nutritional imbalance.

Refined carbohydrates, sugars, and processed foods containing additives should be completely eliminated from the diet. When possible, organic fruits and vegetables and free-range meats should be consumed.

Vegetable proteins, such as soy, quinoa, and beans are beneficial, in terms of blood sugar control and avoidance of chemical and hormonal additives in meat products. Foods rich in EFAs, especially omega-3 fats, include cold-water fish (e.g., salmon and sardines), walnuts, almonds, pumpkin seeds, and flax seeds.

Evidence has shown the effectiveness of a restricted elimination diet (i.e., the “few foods” approach) in children with ADHD.

According to parent ratings on both the Conners- and ADHD Rating Scales in one study, 62 percent of ADHD children showed at least 50-percent improvement in behavior.

The children who followed the dietary intervention no longer met the DSM-IV criteria for ADHD.

This research further highlights that hypersensitivity to foods and additives may exacerbate ADHD symptoms

Exercise Therapy

There is much evidence to show that physical exercise enhances brain activity and modulates neurotransmitter systems, thereby improving memory, concentration, learning, and mood.

Regular exercise that is cognitively, socially, and aerobically challenging offers the most benefit, facilitating healthy cognitive development and alleviating the symptoms of ADHD.

Supplementary InterventionsEssential Fatty Acids

Various studies have reported the benefits of EFA supplementation in varying dosages, for reducing anxiety, attention difficulties, and behavioral problems in children.

In one clinical trial, high daily doses of fish oil (8-16 g), administered to ADHD children, produced a significant improvement in behavior and attention, as well as reduced hyperactivity and defiance. Daily EFA supplementation or eating foods that are rich in EFAs is recommended.

Vitamin B6 and Magnesium

Vitamin B6 facilitates the production of serotonin, and supplementation with vitamin B6 has been shown to increase serotonin levels and reduce hyperactivity in ADHD. In one study, 40 children with ADHD were given magnesium (6 mg/kg/d) and vitamin B6 (0.6 mg/kg/d) for eight weeks.

Almost all ADHD children showed an improvement in clinical symptoms, namely hyperactivity, hyperemotivity/aggressiveness, and inattention. Clinical symptoms returned a few weeks after treatment was stopped.

Iron and Zinc

In a 12-week, double-blind study, children supplemented with 150 mg of zinc sulfate showed reductions in hyperactivity, impulsivity, and impaired socialization.

Supplementation with iron and zinc is only recommended in children who are deficient, and should preferably be in chelated form (i.e., complexed with picolinic acid, amino acids, or organic acids) for improved absorption.

Calcium/Magnesium

Calcium and magnesium work synergistically to relax the nervous system; deficiency symptoms include irritability, restlessness, fidgeting, muscle cramps, and twitches. Magnesium supplementation has been shown to reduce excitability and improve concentration in children with low serum- and RBC magnesium levels.

Herbal Treatment

Certain herbal medicines, as shown in Table 3, show promise in the treatment of ADHD; however, very little research exists regarding their specific use for this condition in children. Those herbs that may be potentially beneficial for ADHD are discussed below.

Various studies have revealed
that Rhodiola exhibits an adaptogenic effect, is neuroprotective, and has
CNS-stimulating activity. Rhodiola has been shown in rats to enhance the
transport of serotonin precursors (tryptophan and 5-HTP) into the brain,
thereby increasing serotonin levels.

Rhodiola also appears to inhibit
acetylcholine esterase, the enzyme that degrades acetylcholine.

A number of clinical trials
have demonstrated that Rhodiola extract has anti-fatigue and anti-anxiety effects
that serve to increase mental performance and cognition (particularly the
ability to concentrate) in adult subjects. Rhodiola also appears to be useful
for generalized anxiety disorder, as well as mild-to-moderate depression.

However, the use of Rhodiola in
combination with conventional antidepressants should be medically supervised,
as concurrent use may increase the risk of adverse effects.

General lack of side effects in
the course of clinical trials makes it potentially attractive for use as a safe medication;
however, no trials have been conducted
on children with ADHD.

Chamomile (Matricaria
chamomilla)

This plant, belonging to the
Compositae family, has known carminative and mild sedative properties and has
traditionally been prescribed for restlessness and nervous irritability in
children.

While generally considered
safe, allergies to plants of the Compositae family may predispose to atopic reactions
and anaphylaxis.

This is, however, extremely rare, and this risk is diminished
if using an ethanolic tincture, as the alcohol in the extract denatures the
proteins responsible for allergic reactions.

St.
John’s Wort (Hypericum perforatum)

Experimental studies suggest
that St. John’s wort is capable of
inhibiting the reuptake of serotonin,
norepinephrine, and dopamine; many of
its compounds appear to contribute to its antidepressant activity.

As a result,
St. John’s wort
offers an alternative option to conventional SSRI antidepressants for treating
mild-to-moderate depression, even in children under the age of 12, and with few
side effects.

The European Scientific
Cooperative on Phytotherapy (ESCOP) recommends this herb for the treatment of
restlessness, anxiety, and irritability.

In one small open trial, St. John’s wort improved ADHD symptoms, according
to the Conners Rating Scale. The use of St.
John’s wort in combination with certain conventional
medications is contraindicated and should therefore be used under medical supervision.

Valerian (Valeriana
officinalis)

Valerian acts primarily on the
nervous system, with calmative and antispasmodic properties. It has been used
for the treatment of anxiety and insomnia, and more recently for ADHD.

Valerenic
acid, one of its key compounds, inhibits the breakdown of GABA in the CNS,
making it an alternative option for disorders characterized by restlessness.

Although
valerian is generally considered safe, there are no studies specifically
evaluating its safety in children, and, to date, no controlled trials
evaluating its use in treating ADHD.
ESCOP approves of the use of valerian for children ages 3-12 years, assuming
medical supervision.

Bacopa (Bacopa monniera) Bacopa, an Ayurvedic herb, has
been used for centuries as a brain tonic to promote higher cognitive
functioning, with more recent research revealing its nootropic action (positive
effects on memory, learning, and concentration).

In one study involving healthy
subjects, the Bacopa (300 mg) group showed a significant improvement in speed
of visual processing, learning rate, and memory consolidation, as well as
reduced anxiety, when compared to the placebo group. Bacopa was most effective after
a 12-week period of supplementation.

Another study conducted on children with
ADHD revealed that Bacopa-treated patients (50 mg twice daily) showed
significant improvements in memory and learning tasks over a 12-week period. Bacopa
appears to be well tolerated, with few adverse effects.

Homeopathic Treatment

Homeopathy is increasingly
becoming a sought after treatment option for ADHD. Homeopathy is a system of
medicine which considers that each individual will both present and experience
their illness characteristically and that there will be a specific medicine
best suited to each individual.

This specific remedy is known as the similimum.

Because not all children diagnosed with
ADHD manifest symptoms of the condition in an identical manner, the task of the
homeopathic practitioner, in treating with the homeopathic similimum, is to
find this remedy based on the individual and characteristic symptoms of the patient with
ADHD.

The homeopath has to know all
the patient’s symptoms – mental, emotional, general, or local.

All
corresponding sensations, concomitants, alternating symptoms, as well as rare
or peculiar characteristic manifestations of the patient and a personal medical
history, are needed for the homeopathic prescription of the similimum remedy.

Mental
and emotional symptoms are given priority in understanding the disease process
of the sick, as well as symptoms that characterize the uniqueness of individual
symptoms.

The philosophy of homeopathy thus implies treating the patient, not
the disease.

Apart from the similimum remedy, many homeopaths make use of
combination remedies, which are a complex of multiple, individual remedies that
clinically relate to a particular condition.

These combination remedies are
sometimes used as a substitute for similimum, or “constitutional,” prescribing.

Various research studies on both similimum and combination homeopathic
treatment of children with ADHD have been conducted, many of which have shown
success in their treatment regimens.

Strauss, in a study to determine the
efficacy of Selenium Homaccord®, a homeopathic complex, in the management of
ADHD, observed overall improvement in children’s symptoms.

A study conducted by
Smith et al found that the homeopathic complexes, Cerebro® and Nerva 2®,
reduced the symptoms of inattention and improved the scoring of the Conner’s
Abbreviated Teacher Rating Scale in children with ADHD, ages 7-12 years.

White
et al studied the effects of Valeriana officinalis in mother tincture (MT) and
3X potency and observed a significant improvement in ADHD children’s behavior
while on the treatment, with no significant difference found between the MT and
3X potency.

Homeopathic complexes may provide symptomatic relief without any
adverse effects; however, more research is required to verify these
results.Several studies have been conducted on similimum treatment.

In 1997,
Lamont conducted a double-blind, partial crossover study of 43 children with
ADHD. Children were treated initially with either placebo or a similimum
homeopathic remedy; after 10 days, the groups were switched. According to
behavior rating scores by parents or caretakers, homeopathic treatment was
found superior to placebo for reducing symptoms of hyperactivity.

A similimum research study by Barnard
et al showed that 85 percent of the participants in the study group improved in
symptoms of ADHD on their homeopathic
similimum remedy over the 12-week treatment period. Frei and Thurneysen carried
out a study comparing similimum
homeopathic treatment (using LM potencies,
meaning a 1/50,000 dilution ratio) and Ritalin treatment.

Of the 115
participants, 75 percent responded sufficiently well to homeopathic treatment,
22 percent did not and needed Ritalin, and
three children did not respond to either treatment.

A Swiss randomized,
double-blind,placebo-controlled, crossover
trial by Frei et al set out to obtain scientific evidence of the effectiveness
of homeopathy in ADHD treatment.

Each of the 83 children diagnosed with ADHD
was individually prescribed homeopathic medication in LM potency.

Sixty-two participants who responded well to the treatment were considered eligible
for the study; these children were
divided into two groups and received
either their similimum remedy for six weeks, followed by placebo for six weeks,
or vice versa.

The results showed that the overall intensity of ADHD symptoms
appeared lower during treatment compared to placebo and resulted in an
improvement in the children’s social, emotional, and scholastic behavior.

Similimum therapy appears to
offer benefits to ADHD sufferers.

Efficacy of the treatment, however, depends
on the accuracy of the prescription.

Further research on the homeopathic
treatment of ADHD is required in order to establish its efficacy and to develop
future treatment protocols.

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Source: Complementary and
Alternative Medical Therapies for Children with Attention-Deficit/Hyperactivity
Disorder (ADHD).